Research report
The course of anxiety and depression through pregnancy and the postpartum in a community sample

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Abstract

Background: Postnatal and antenatal depression are a focus of considerable clinical and research attention, but little is known about the patterns of anxiety across this period. Methods: Self-reported anxiety and depression were assessed at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally in a prospective longitudinal study of a community sample of women in England (n=8323). Results: The majority of cases of postnatal depression were preceded by antenatal depression; similarly, postnatal anxiety was preceded by antenatal anxiety. Despite the stability of anxiety and depression across this period, there was a mean decrease in both anxiety and depression. Finally, antenatal anxiety predicted postnatal depression at 8 weeks and 8 months, even after controlling for antenatal depression (OR=3.22, p<0.001). Limitations: Data were based on self-report only and there was evidence of selective attrition. Conclusion: The findings confirm that antenatal anxiety occurs frequently, overlaps with depression and increases the likelihood of postnatal depression.

Section snippets

Sample and procedure

The study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC) a longitudinal, prospective study of women, their partners and an index child (Golding et al., 2001). The study included all pregnant women living in the geographical area of Avon, England who were to deliver their baby between 1 April 1991 and 31 December 1992. It was estimated that 85–90% of the eligible population took part. All data were collected via postal questionnaires.

Of the 13,617 ALSPAC mothers who

Attrition

We tested whether women who reported high levels of anxiety and/or depression in pregnancy were disproportionately likely to drop out of the study by 8 months postpartum. One-way ANOVAs for each of the 8 scores (4 depression assessments and 4 anxiety assessments) comparing the final sample of 8323 with those cases removed from the sample but with a valid figure for the relevant score showed differences of between 0.9 and 1.4 points for EPDS (on a 30-point scale) and between 0.4 and 0.8 points

Discussion

The aims of this study were to examine symptoms of depression and anxiety across the transition from pregnancy to the postpartum. The central findings were that, for both depression and anxiety, there was considerable stability in individual differences as well as a mean decrease in symptoms from pregnancy to postpartum. For anxiety, the drop in mean level amounted to approximately 0.4 of a standard deviation. Furthermore, only a minority of cases of either depression or anxiety were not

Acknowledgements

The ALSPAC study is part of the WHO initiated European Longitudinal Study of Pregnancy and Childhood. We are extremely grateful to all of the mothers who took part and to the midwives for their cooperation and help in recruitment. The whole ALSPAC study team comprises interviewers, computer technicians, laboratory technicians, clerical workers, research scientists, volunteers and managers who continue to make the study possible. ALSPAC has been funded by The Wellcome Trust, the Department of

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